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Pouchitis in young patients after the ileal pouch-anal anastomosis
J Perrault1, R Berry, J Greseth
1Department of Pediatrics, Mayo Graduate School of Medicine; *Riverside Medical Clinic, Riverside, CA; †Department of Pediatrics, Mayo Clinic and Mayo Foundation; ‡Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and §Department of Pediatric Surgery, St. Paul Children's Hospital, St. Paul, Minnesota, U.S.A.
Insights
Pouchitis is a common complication after ileal pouch-anal anastomosis in young patients, affecting nearly half of those with ulcerative colitis. No predisposing factors were identified in this long-term study.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease
Background:
- Inflammatory bowel disease, particularly ulcerative colitis, often necessitates surgical intervention.
- Ileal pouch-anal anastomosis (IPAA) is a common surgical procedure for ulcerative colitis and familial polyposis.
- Pouchitis, inflammation of the ileal pouch, is a known complication following IPAA.
Purpose of the Study:
- To determine the incidence of pouchitis in young patients who have undergone IPAA.
- To identify potential predisposing factors for pouchitis development.
- To analyze clinical variables differentiating acute from chronic pouchitis.
Main Methods:
- Long-term follow-up of 97 young patients (83 with ulcerative colitis, 14 with familial polyposis) after IPAA.
- Kaplan-Meier method to assess survival free of pouchitis.
- Logistic regression analysis to identify factors associated with acute versus chronic pouchitis.
Main Results:
- Pouchitis developed in 47% of patients (53% of ulcerative colitis patients, 14% of familial polyposis patients).
- Common symptoms included loose/frequent stools (92%), incontinence (62%), and bloody stools (62%).
- Endoscopic findings of erythema and friability were universal in affected patients; ulcers were present in 35%.
Conclusions:
- Pouchitis is a frequent long-term complication after IPAA in young patients with ulcerative colitis.
- No specific predisposing factors for pouchitis were identified in this cohort.
- Metronidazole was the primary treatment, with some patients requiring sulfasalazine and/or steroid enemas.
Summary:
: The purpose of this study was to determine the incidence of pouchitis after the ileal pouch-anal anastomosis in young patients, and to identify possible predisposing factors. The study design included long-term follow-up of young patients after closure of their temporary diverting ileostomy, through regular visits, a detailed questionnaire, or phone call. The Kaplan-Meier method was used to summarize survival free of pouchitis in several subgroups. A logistic regression analysis of just the patients with pouchitis was used to determine whether any clinical variables could discriminate between those with acute and those with chronic pouchitis. We are closely following 97 patients with an ileal pouch-anal anastomosis-83 patients for chronic ulcerative colitis and 14 patients for familial polyposis. They have been followed for a median of 7.5 years (range 1-14.5 years). Forty-six patients (47%) developed pouchitis-44 (53%) patients after ulcerative colitis and 2 (14%) patients after polyposis. Most (92%) had loose and/or frequent stools, many had incontinence (62%) and bloody stools (62%), and less (37%) had cramping. Endoscopy was done in 82% of the patients; erythema and/or friability was seen in all patients, often with ulcers or erosions (35%); no polyposis patients had ulcers. We could not identify any predisposing factor. Metronidazole was the treatment of choice, but some patients required long-term treatment with sulfasalazine and/or steroid enemas. Pouchitis is a common long-term complication of the ileal pouch-anal anastomosis after ulcerative colitis. No predisposing factor has yet been identified in these young patients.
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